大泡性角膜病变18例手术治疗效果回顾性分析

目的:评价羊膜移植几种手术方法治疗大泡性角膜病变的临床效果。方法:对18例大泡性角膜病变患者,分别采取角膜层间烧烙术、新鲜羊膜移植术、角膜灼烙联合羊膜嵌入移植手术。结果:18例大泡性角膜病变患者,术后1～5d疼痛消失,7～12d角膜上皮修复,7～21d后羊膜植片常规溶解。角膜层间烧烙术1眼、新鲜羊膜移植术3眼术后1～2mo再次出现角膜大泡及角膜刺激症状而再次手术。角膜灼烙联合羊膜嵌入移植术,术后当天疼痛消失,14d角膜上皮光滑,角膜大泡消失。随访6～18mo无1例复发,部分患者视力有不同程度的提高。结论:角膜灼烙联合羊膜嵌入移植对大泡性角膜病变具有明显的治疗效果。     

大泡性角膜病变的眼外科处理

目的：寻求一种安全有效的手术方案，使大泡性角膜病变获得增视或解除痛苦的临床效果。方法：对角膜表面羊膜贴敷、角膜基质热凝 羊膜贴敷、角膜层间羊膜植入、角膜层间晶状体后囊膜植入、角膜层间前囊膜植入、角膜内皮板层移植等6种术式共40只眼作回顾性临床研究。结果：角膜表面羊膜贴敷术中58％(7／12)、角膜层间羊膜植入75％(3／4)刺激症状消失或减轻；角膜基质热凝 羊膜贴敷100％(8／8)大泡消失，但视力无改善；角膜层间晶状体后囊膜植入100％(10／10)和前囊膜植入100％(4／4)大泡消失伴视力轻微改善；角膜内皮板层移植100％(2／2)大泡消失，角膜恢复透明并获得0．3以上视力。结论：单纯的羊膜贴敷不足以阻止角膜基质水肿和上皮大泡形成；角膜基质热凝造成的瘢痕能阻止上皮大泡形成。但无助于视力的改善；晶状体前／后囊膜具有良好的物理性屏障作用，能够减轻角膜基质水肿和阻止上皮大泡形成，但仍难获得有用视力；带有活性内皮的内皮板层移植，帮助受体重获内皮的物理性屏障功能和代谢性泵功能，角膜透明的生理属性得以恢复，是一种安全的增视性手术。     

羊膜移植治疗大泡性角膜病变

目的 :探讨施行羊膜移植术治疗大泡性角膜病变的临床效果。方法 :对 11例 ( 11眼 )大泡性角膜病变患者施行羊膜移植术。结果 :羊膜移植后随访 1～ 7个月间 ,术前难以忍受疼痛的 11例中 10例 ( 91% )术后疼痛消失 ,1例疼痛减轻。有 4例 ( 36 % )术后视力提高 ,9例 ( 82 % )角膜上皮在 5周内迅速愈合 ,另 2例角膜大泡局限于小区域。结论 :羊膜移植术为大泡性角膜病变的有效方法 ,与继往其他方法比较具有明显优越性     

羊膜移植术治疗大泡性角膜病变

目的：探讨施行羊膜移植术治疗大泡性角膜病变的临床效果。方法：对11例（11只眼）大泡性角膜病变患者施行羊膜移植术,结果：羊膜移植术后随访1-7个月间,术前难以忍受疼痛的11例中10例（91%）术后疼痛消失,1例疼痛减轻。有4例（36%）术后视力提高,9例（82%）角膜上皮在5周内迅速愈合,另2例角膜大泡局限于小区域。结论：羊膜移植术为治疗大泡性角膜病变的有效方法,与继往其他治疗方法比较具有明显优越性。     

角膜基质层烧烙联合羊膜移植治疗大泡性角膜病变

目的探讨角膜基质层烧烙联合羊膜移植治疗大泡性角膜病变（BK）的临床疗效。方法对9例（9只眼）大泡性角膜病变的患者行角膜基质层烧烙联合羊膜移植,其中白内障联合人工晶状体植入术后5例,抗青光眼术后3例,角膜穿通伤1例。结果术后眼部刺激症状、角膜上皮大泡均于1周内消退,角膜基质水肿7～10d消失。术后随访3～24个月,均未发现BK复发及并发症的发生。结论对于症状明显、病情顽固、难以恢复有效视力且不具备角膜移植条件的BK患者,角膜基质层烧烙联合羊膜移植可有效控制BK的症状,防止BK的复发,是治疗BK可供选择的有效方法。     

新鲜羊膜移植治疗大泡性角膜病变的临床观察

目的:观察新鲜羊膜移植治疗大泡性角膜病变的临床疗效,探讨大泡性角膜病变有效可行的治疗方法。方法:回顾分析经新鲜羊膜移植进行治疗的13例13眼大泡性角膜病变,其中人工晶状体眼10例,绝对期青光眼2例,外伤性晶状体前脱位1例。对13例患者术后眼部刺激症状消失时间、大泡消失例数、羊膜溶解时间、角膜上皮完全修复时间、视力改善状况进行分析评价,同时与报告中大泡性角膜病变的其他治疗方法上述指标比较。结果:13例大泡性角膜病变患者中10例在术后3d内疼痛消失,13例大泡消失,14d内移植的新鲜羊膜全部溶解,无1例出现排斥反应,14d内角膜上皮完全修复,与报告中除角膜移植外的视力改善率有显著性差异(P<0.05)外,与其余同类方法相关指标比较无统计学差异。结论:新鲜羊膜移植治疗大泡性角膜病变是取材方便、费用低廉、效果可靠的治疗方法。     

角膜表面及层间联合生物羊膜移植治疗大泡性角膜病变

目的探讨生物羊膜移植治疗大泡性角膜病变的方法和疗效。方法对13例(13只眼)大泡性角膜病变患者行角膜表面及层间联合生物羊膜移植术,并对其进行近期和远期的疗效观察。结果13例(13只眼)患者角膜愈合好,眼部症状消失,无复发、无不良反应。结论角膜表面及层间联合生物羊膜移植术对减轻大泡性角膜病变炎症反应和疼痛,重建角膜表面,防止大泡性角膜病变复发有非常好的治疗效果,且手术安全、简单易行、取材容易、疗效可靠,值得临床应用。     

自体板层角膜转位联合层间烧灼及羊膜移植术治疗大泡性角膜病变

目的 探讨自体板层角膜转位联合层间烧灼及羊膜移植术在大泡性角膜病变治疗中的临床效果.方法 选取大泡性角膜病变患者6例(6眼),均有明显刺痛、流泪症状.其中白内障术后3例;白内障术后继发青光眼1例:青光眼术后并发白内障1例:角膜异物取出术后1例.6例患者均行自体板层角膜转位联合层间烧灼及羊膜移植术治疗.结果 6例患者术后眼病等刺激症状基本消失,角膜上皮完整,随访3～12个月均未发现大泡性角膜病变复发及并发症出现,视力有轻度提高.结论 自体板层角膜转位联合层间烧灼及羊膜移植术可有效缓解大泡性角膜病变的症状,是解除视功能不佳的大泡性角膜病变患者临床症状的有效方法.     

嵌入法羊膜移植治疗大泡性角膜病变

目的：评价嵌入法羊膜移植治疗大泡性角膜病变的临床效果.方法：对16例（16眼）大泡性角膜病变患者施行嵌入法羊膜移植治疗.结果：羊膜移植术后随访3-6mo,角膜上皮10d内均完全修复,14例疼痛完全消失.2例周边角膜局限小泡,4例术后视力提高.结论：嵌入法羊膜移植治疗大泡性角膜病变是有效可行的.     

羊膜移植治疗大泡性角膜病变

目的：研究羊膜移植治疗大泡性角膜病变的疗效。方法：对15例（15只眼）大泡性角膜病变患者采用羊膜移植治疗。其中无晶状体眼5例,人工晶状体眼5例,有晶状体眼者3例,角膜移植片失败者2例,结果：随访期3－12个月,治疗后1－3天内症状解除者13例（86．67％）,症状减轻者2例,氖患者角膜上皮缺损在3－4周内愈合。结论：羊膜移植能有效地控制大泡性角膜病变的症状,促进上皮愈合,且安全、简便,易行,具有很大的发展前途。     

角膜层间烧灼联合错位神经根切断及羊膜覆盖术治疗大泡性角膜病变

目的 观察角膜层间烧灼联合错位角膜神经根切断及羊膜覆盖术治疗大泡性角膜病变的临床疗效。方法 选取有明显眼痛且视功能差的大泡性角膜病变患者28人（28只眼）,其中白内障摘除联合人工晶体植入术后16只眼,单纯白内障摘除术后2只眼,白内障针拨术后1只眼,青光眼白内障联合术后3只眼,青光眼滤过术后2只眼,闭角型青光眼绝对期1只眼,眼外伤2只眼,玻璃体切割术后1只眼。对28只眼均行角膜板层切开,层间烧灼,错位角膜神经根切断及羊膜覆盖术。术后随诊观察6～ 32个月,平均18月。结果 术后28只眼中25只眼(89.3％)术后疼痛感消失,3只眼(10.7％)疼痛明显缓解。术后1月8只眼(28.6％)视力提高,20只眼(71.4％)视力同术前。羊膜于术后5 ～45天脱落或溶解,平均28.8天。 术后26只眼(92.9％)角膜上皮在1月内愈合,角膜大泡完全消失,2只眼(7.1％)角膜大泡范围明显缩小。28只眼角膜基质水肿均减轻。随访6～ 32个月均未发现症状复发,角膜大泡复发或其他并发症出现,患者原有残存视力保留或提高。结论 角膜层间烧灼联合角膜错位神经根切断及羊膜覆盖术是缓解视功能差的大泡性角膜病变患者疼痛症状的有效的手术方法。     

Use of amniotic membrane transplantation for treating bullous keratopathy

One of the complications of cataract surgery is bullous keratopathy, which is the result of decompensation of the corneal endothelium. The clinical signs are manifested in stromal and epithelial edema with bullae producing. The amniotic membrane, which is taken from the placenta of young mothers during the caesarean section, may have beneficial influence on the process of healing the corneal structure. The study aimed to evaluate effectiveness of bullous keratopathy treatment using amniotic membrane transplantation, as an alternative method of treatment after cataract surgery. MATERIAL AND METHODS: The amniotic membrane transplantation was performed in 18 eyes of 18 patients (10 females and 8 males), aged 62 to 85 with the bullous keratopathy. After removing the pathologically changed epithelium, the amniotic membrane was covered on cornea in local anesthesia, using interrupted sutures 10.0 nylon. A therapeutic contact lens were applied. Control examinations were performed 3, 6 and 12 weeks after the operation. The best corrected visual acuity was evaluated. The local state was investigated using slitbiomocroscopy and confocal microscopy. RESULTS: In all the patients' regression of subjective complaints was observed (pain, light sensitivity and tearing). In 12 cases improvement of visual acuity was achieved. The evaluation of corneas in slit biomicroscopy revealed greater clarity and less corneal edema. On confocal microscopy, decrease in blurred collagen fibers and background illumination were observed. The epithelium contained cystic structures (blisters) in 6 cases only. The endothelial cells were pleomorphic and polymegathic. CONCLUSION: The amniotic membrane transplantation is an effective method of treatment for bullous keratopathy and has beneficial influence on the process of corneal healing and the improvement of visual acuity and diminish subjective symptoms.     

Cryopreserved amniotic membrane transplantation for the management of symptomatic bullous keratopathy

Background: To report the results of cryopreserved human amniotic membrane transplantation for the management of symptomatic bullous keratopathy. Methods: Prospective non‐comparative interventional case series study. Consecutive cases with symptomatic bullous keratopathy for more than 12 months not amenable to conservative treatment were managed with amniotic membrane transplantation. They were recruited over a 5‐year period (September 1999 to November 2004) in one referral centre. Only one eye of each patient (the worse affected eye in bilateral cases) was operated. A 360 degree conjunctival peritomy was followed by removal of the diseased corneal epithelium. Amniotic membrane was transplanted over the cornea as a patch and sutured to the free conjunctival edges. Primary outcome measures were ocular pain and epithelial defects; secondary measures were visual acuity and ocular surface inflammation. Results: Four out of 85 recruited cases did not complete the minimum observation of 12 months and were excluded from the study. The mean follow‐up period for the remaining 81 cases was 21 ± 4.2 months (range 14–34 months). Seventy‐one (87.6%) eyes became asymptomatic with healed epithelium, seven required repeated amniotic transplantation and three underwent penetrating keratoplasty. Visual acuity improved in 64 (79%) patients and remained unchanged in 14. No complications were recorded. Conclusions: Amniotic membrane transplantation is an efficient and safe treatment for symptomatic bullous kerato pathy, when penetrating keratoplasty is not available. It has been shown to alleviate pain, promote corneal epithelialization and reduce conjunctival inflammation whereas in some cases it may also improve visual acuity.     

生物羊膜联合治疗性角膜软接触镜治疗角膜溃疡

目的:探讨角膜溃疡患者行生物羊膜联合治疗性角膜软接触镜的治疗效果及可行性。方法:对33例35眼角膜溃疡患者进行削除病变组织,在植床平铺与溃疡面大小相仿生物羊膜(溃疡较深行多层羊膜覆盖填塞),将稍大于溃疡灶的外层生物羊膜与周围正常角膜组织间断缝合,术后第2d配戴治疗性角膜软接触镜,并针对不同病因的角膜溃疡点用治疗性眼药水。结果:所有患者1～2d内恢复前房,1wk左右局部刺激症状明显好转,溃疡平均愈合时间30～45d,5例患者见新生血管长入,角膜不同程度的瘢痕形成,2例角膜溃疡前房反复消失,后行穿通性角膜移植。治疗后视力均有不同程度的提高。结论:此方法能有效修复角膜溃疡组织,为后期角膜移植创造良好的局部条件。     

不同受者同期分别接受同者的角膜移植五例

目的 为提高角膜材料的利用率,探讨将同一噶供者的二个角膜同期移植给不同受者的可行性及手术方法.方法 供者的其中一个角膜材料分别为1例角结膜恶性黑色素瘤,1例蚕蚀性角膜溃疡伴穿孔行前部分板层角膜移植术,并对1例大泡性角膜病变行深板层角膜内皮移植术.另一个角膜材料分别为眼烧伤后重度睑球粘连行全板层角膜移植和1例大泡性角膜病变行深板层角膜内皮移植术.结果 5例角膜病患者手术均获得成功,其中2例大泡性角膜病变患者术后1个月,角膜上皮水泡消失,角膜水肿减轻,内皮植片透明.1例角结膜恶性黑色素瘤患者,视力术前0.3提高至术后0.6,植片透明,角膜植床及结膜无色素残留.1例蚕蚀性角膜伴穿孔经羊膜移植联合部分板层角膜移植治愈.1例眼烧伤睑球粘连患者,术后1个月,睑球粘连完全解除,植片透明,视力由术前0.1提高到0.3.结论 将同一供者的角膜分别移植给不同受者,能充分利用供者角膜材料,方法可行,效果良好.     

羊膜移植治疗反复性角膜上皮糜烂

目的 探讨羊膜移植治疗反复性角膜上皮糜烂的临床疗效.方法 回顾性分析保存生物羊膜移植治疗的20例（21眼）反复性角膜上皮糜烂住院患者,术后随访观察3～16个月,对术后角膜上皮完全修复时间、视力提高情况进行分析评价.结果 21眼中19眼单纯羊膜移植术,术后角膜上皮完全修复时间最短3d,最长28 d;1眼于术后第8天羊膜融解,角膜上皮未愈合,经再次手术并联合佩戴角膜接触镜治疗后角膜上皮完全修复;1眼首次手术及联合佩戴角膜接触镜治疗,术后7d角膜上皮完全修复.术后视力提高（t=2.613,P=0.02）.结论 羊膜移植是治疗反复性角膜上皮糜烂的有效方法.     

Secondary intraocular lens implantation during or after corneal transplantation

An analysis of the effects of secondary intraocular lens implantation on the clinical results of corneal transplantation in four groups of eyes showed that the mean visual acuity in 27 eyes undergoing intraocular lens implant at the time of aphakic keratoplasty and in 12 eyes undergoing intraocular lens implantation after corneal transplant was approximately 20/40; the visual acuity in 24 eyes undergoing intraocular lens exchange at the time of transplant for pseudophakic bullous keratopathy and in 18 eyes undergoing intraocular lens removal at the time of transplant for pseudophakic bullous keratopathy was poorer. The techniques used were simple and did not increase the incidence of transplant complications. Intraocular lens implantation combined with corneal transplants should be considered in aphakic eyes requiring corneal transplants, in eyes requiring simultaneous cataract extraction and corneal transplants, and in eyes in which cataracts have developed after corneal transplant.